This invention relates to management information systems for monitoring the public health, and, more particularly, to a computerized system for collecting information relevant to the incidence and type of disease and other off-nominal medical conditions among the general population, and compiling and analyzing that information. The system alerts the public health authorities to the presence of particular diseases or other off-nominal medical conditions in defined geographical regions, including diseases or other off-nominal medical conditions that could result from an act of biological or chemical terrorism; and serves as an xe2x80x9cearly warning networkxe2x80x9d for events of biological causes.
Public health management information systems gather information on the incidence of disease, information that enables the health authorities to act and, ideally, block the outbreak of an epidemic of disease. As a public health measure, the various States of the United States currently require treating physicians to notify public health authorities of the discovery of certain contagious diseases in a patient. The physician may give that notice by telephone or facsimile. Through that notification procedure relevant data of disease is collected.
Although the purpose of that notification is commendable, the procedure takes time from the physician""s very busy schedule (or that of the physician""s staff). In recent years physicians (and the physician""s staff) have become busier than ever, overloaded with patients and paperwork, which inhibits reporting. Even so, the foregoing manual reporting system works, particularly when the disease is recognized as being of a very serious nature. As example, as reported in the newspapers recently, when a female business traveler, who flew by airplane between an African country to Canada and to the U.S., fell ill and was thought to have contracted the deadly and highly contagious Ebola virus, the reporting was swift. The report was followed by quick action taken by the public health authorities.
In addition to the reports prepared by physicians, there are other potential sources of important information regarding public health that may be culled. Examples include statistical information regarding the purchase of over-the-counter medications, and statistical information regarding school absence rates and work absence rates. The collection and compilation of such statistical information very labor-intensive and not done systematically.
For the majority of diseases or other off-nominal medical conditions, however, the foregoing collection and/or reporting procedure is unreliable, uncertain, and slower than desired. The public health authorities might even wish that it were possible to learn of the incidence of a disease without troubling the attending physicians or their staff. As an advantage, the present invention accomplishes such a task. With the present invention, pertinent data are gathered from many sources, including those previously cited; and the invention provides rapid and reliable correlation of such multi-source data into a more timely and more reliable warning of biological incidents.
Typically a large time delay occurs between the occurrences of a biological event, such as caused an accidental spill, accidental contamination, or an act of biological terrorism, and the time at which the public health authorities are able to conclude that a biological event is underway. In part, the delay is due to the gestation period of the biological agents that were released by the event, but most of the delay is caused by failing to notice a pattern of events until the effects are quite pronounced. Typically, the delay is on the order of a few weeks. Given the propagation patterns of biological agents, shortening delays in detection would have a major benefit in containment, diagnosis, and treatment.
For example, assume that a water plant serving a particular community becomes contaminated. Such contamination might be caused by a contaminated filter or by a filter that is incorrectly prepared prior to being placed in service. Such contamination might also be deliberately caused by an act of terrorism. In either event, some time will lapse before anyone notices the contamination or the effect of the contamination. The incident is likely to be more severe if the time delay to detection is longer, and less severe if the time delay is shorter. Hence, approaches that shorten the time delay are highly advantageous.
One device that could give notice is the monitoring device for the water of the treatment plant. The existing state of the art for sensors that are able to detect biological agents, however, appears to be fairly primitive. Existing sensors tend to be expensive, slow, require large sample sizes, and have no effective xe2x80x9cstand-offxe2x80x9d range (e.g., they must be located in very close physical proximity to the event). For many threat scenarios, the more likely xe2x80x9cfirst noticexe2x80x9d is less direct: The symptom observed is that many people start to fall ill. It is recognized that at any given time and place, a large number of people fall ill for many reasons. But by noticing that an abnormal trend of illnesses is taking place, one is able to ultimately detect the foregoing contamination.
The foregoing example of water plant contamination is not theoretical. Not long ago the population of a large city in the northern U.S. suffered a large number of illnesses and even deaths due to what turned out to be a fault in a local water treatment facility. First it was noticed that many people inexplicably became seriously ill; some died. After a while it became apparent that rates for certain events were well above normal. Only many weeks thereafter was information correlated to the point where the authorities were able to form a hypothesis regarding the cause. And more time passed before the correct cause was found and corrected. From the perspective of public health, the incident would have unfolded exactly the same way if the cause of the incident were due to deliberate contamination of the water treatment plant, rather than poor maintenance (as turned out to be the case). In the foregoing, the effect described appeared well before the cause could be determined.
An after-the-fact analysis of the incident shows that the first potential indicator of a problem was a huge increase in the purchase of over-the-counter anti-diarrhea medications. This was followed (several days later) by an increase in doctor visits by patients with similar complaints. Even later, hospitalizations and deaths followed. The present inventors recognize that the affected population turned first to self-diagnosis and self-medication, and only sought professional advice several days thereafter. Thus, the first clue of the existence of a problem would have been indications of the increase in the purchase of over-the-counter medications. As an advantage, the present method looks to the latter purchase information automatically. With the method described herein the foregoing incident would have unfolded differently. Through automatic culling of the first indication information as offered by the present invention, the method would have led to diagnosis and correction of the problem several weeks earlier than actually occurred. Many illnesses could have been moderated or avoided, and many deaths perhaps could have been avoided.
The foregoing example originated in part due to the neglect of some person or other. Diseases may also be cultivated and broadcast by nations as a weapon of war for disabling an enemy, or even as a weapon of terrorism. Terrorism is a technique by which a militarily-impotent barbaric state may secretly wage war (or, following defeat, continue to wage war) against a more powerful but xe2x80x9ccivilizedxe2x80x9d opponent in the hope that the terrorist acts cripple and/or demoralize the civilized foe to the point where the civilized foe loses its xe2x80x9cwillxe2x80x9d, and is internally rendered defenseless. Because of the ability of a terrorist to hide their role if they elect to do so, the civilized state is without proof as to the source of the terror, and, typically, is therefore unable to take direct action against the perpetrator. Indeed, the perpetrator may not even be a nation-state, but may be individuals or private organizations.
One typically equates a terrorist act with bombs exploding for maximum effect in heavily populated locations. Despite the damage caused, the range of a bomb is limited. Nor does bomb damage continue to grow over time. However, a disease that is easily spread, such as by the wind, can cover much larger regions, causing greater numbers of innocents to become sickened and/or die. And, because biological agents are alive and can continue to grow and multiply, the damage can actually increase over time.
Biological terrorism is a present serious concern. Civilized nations remain apprehensive of the possibility of such a biological terrorist attack. In particular, with the existence of a predator in control of a nation creating weapons of mass destruction and secretly conducting a war of terrorism, nations are well advised to monitor for surreptitious biological attack. To do so in great part leads one back to the existing public health management information system earlier described, and the delays attendant therein.
A need therefore exists for a more effective means for early detection of the incidence of disease and other off-nominal medical conditions. As an advantage, the present invention provides early warning of a potential epidemic or biological attack, or at a minimum, places officials on notice of facts bearing further investigation. The invention is effective against deliberate events (e.g., biological terrorism), accidents causing release of biological agents (e.g., the defective filter in the water treatment plant, as in the above example), and natural biological events (e.g., epidemics).
Ideally, an effective monitoring system is one that is practical, inexpensive, easily replicated, and makes use of existing infrastructure to the greatest extent possible. The present invention fulfils each of those goals.
The present invention is based on observation of human nature. As applicants have observed, when feeling bad, people often self-diagnose their condition and attempt to self-medicate before resorting to a visit to a doctor. On a macro scale, the purchase of over-the-counter medicines provides the earliest clue. As example, increased sales of aspirin in a given locale may indicate the onset of the flu, some local event causing stress, or something else. Given the clue (e.g., sales of some over-the-counter medicine significantly higher than normal), health authorities may investigate in that locale for particulars. Additionally, if the symptoms of the illness do not lighten thereafter, but deepen, and the person feels seriously ill, then the person will visit the doctor. Typically, the doctor will issue a prescription for medicine, and the patient will purchase the medicine at a pharmacy. In each case, a record is typically made of the purchase transaction.
Most everyone has witnessed the technological changes introduced in recent time into the modern supermarket, drug stores, and other retail establishments that have dramatically altered the way retail business is done. Such innovations include the bar-code reader, the bar-coded labels on packaging, the cash register that reads the information scanned by the bar code reader, and the credit card reader that is also connected to the cash register, collectively referred to as point-of-sale (xe2x80x9cPOSxe2x80x9d) equipment. The use of POS equipment has greatly increased the efficiency and speed of the check-out procedure, and reduced errors in entering data at the cash register. It also provided the customer with greater information of the purchases that were made.
The receipt handed to the customer includes a print-out that details the identification of the items that were purchased, the individual product prices, the tax, if any, the total price, and even some promotional material or advertising. Often a coupon is printed out and handed to the customer along with the receipt. Typically the coupon is for a product that is of the same kind or competitive to a product that the customer has purchased. Such an action gives rise to another important aspect to the POS equipment that is generally transparent to the customer; the computer of the POS equipment collects and uses information gathered at the cash register, and stores that information in a peripheral memory of the computer, such as a disk drive.
For one, the computer can be programmed to save the information collected by ringing up purchases of an individual customer at the register, scan that information to detect the presence within the purchases of a kind of product whose sales are to be monitored, and, if so, command the print-out at the cash register of a particular coupon for the customer. The information collected from the cash register can be used for inventory control purposes within the store. As example, the initial store inventory is maintained in a database. Each item scanned in a sale may be subtracted from the count of the respective item in the database, lowering the amount in inventory. Store management can determine xe2x80x9cwhat""s hot, and what""s notxe2x80x9d.
Further, when and if the inventory of a particular item is found to fall below the predetermined xe2x80x9creorderxe2x80x9d level set by management for the item, a reorder alert may be printed out at the POS computer. If the particular store is part of a chain of stores, the sale and inventory information is often transmitted daily to headquarters of the chain. Headquarter management is then able to watch for aberrations in the business of any particular store and even xe2x80x9csecond guessxe2x80x9d the manager of the local store. In essence, the database of the POS computer is a relative cornucopia of information.
One might not ordinarily think that the POS system of the drug store or supermarket could serve as a component of a public health management information system. The present applicant recognizes that large volumes of medicines, particularly over-the-counter medications, are sold directly to consumers to cure various ills; and that such sales are presently typically recorded in the database of POS equipment in the retail store. As becomes apparent, as a further advantage the present invention takes advantage of the widespread availability and capability of such POS equipment in the interest of public health and/or the national security. The invention borrows information gathered by existing POS equipment.
Accordingly, an object of the invention is detection of contagious diseases and other off-nominal medical conditions at the earliest opportunity.
Another object of the invention is to provide a method and system for detecting acts of biological terrorism in the general population. And
A further object of the invention is to provide a cost effective disease detection system that is capable of accomplishment through existing technology.
The present invention provides an early warning network that operates against a broad class of public health threats, such as bio-terrorism, accidental biological events, and/or naturally occurring diseases. By periodically extracting information from point-of-sale systems and similar information systems in retail businesses on purchases of medicine during a reporting period, and analyzing the acquired information, one may thereby detect an abnormal trend. Combining the purchase information with information from other sources, such as doctor and hospital reports, and the like, will enhance and speed detection of an abnormal trend.
In accordance with the foregoing objects and advantages, an early warning network for biological events or terrorism produces the alert that calls the health authorities to action. Data generated in the point of sale units of a retail store or pharmacy that sells prescription and non-prescription medicines contains information regarding purchases of various medicines which is available at the servers associated with the point of sale equipment. The databases of purchases are periodically culled to extract information regarding the quantities of different types of medicines purchased in the period, such as a day, and consolidated. The information is transmitted, directly or indirectly, to the servers of the public health authorities. With medicine type correlated to specific diseases, the computers of the health authorities evaluate purchase information on a type-by-type and region-by-region basis, allowing the authorities to identify trends and potential events far earlier than at present.
Protection of privacy and commercially-sensitive information is also a key advantage of the proposed system. The public health authorities (or whomever is operating the proposed system) do not need to xe2x80x9creach intoxe2x80x9d the computer systems of retail store chains in order for the proposed system to function. Instead, the public health authorities need only provide the store chains documentation defining the content and format of the data needed, and the desired frequency of reporting. The retail store chain can program their own computers to extract and formulate the needed information, and send the information to a designated recipient computer via the Internet or similar communication mechanism. The foregoing procedure protects the privacy of commercially sensitive information; the retail store chain need not allow outside organizations to xe2x80x9creach intoxe2x80x9d their computers in order to participate.
As an additional advantage, the system does not need information on a person-by-person basis; aggregated information that has no names or other specific individual identifiers attached is adequate for the purposes of the system. Thus the privacy of the individual consumers who purchase items at the retail store chains is protected. Retail store chains are able to properly advise their customers that no personal information is disclosed via the reporting process. The invention achieves a significant public benefit without any adverse impact on either commercial or consumer privacy.
The foregoing system permits national health authorities to be pro-active in ferreting out a potential epidemic or bio-terrorism event. When a trend is spotted that may indicate an unusual disease in a geographic region, the authorities may immediately contact the hospitals in the region to question unusual events. The authorities can even request samples for analysis from the hospitals for an independent assessment without requiring the identity of the patient.
The foregoing and additional objects and advantages of the invention, together with the structure characteristic thereof, where were only briefly summarized in the foregoing passages, will become more apparent to those skilled in the art upon reading the detailed description of a preferred embodiment of the invention, which follows in this specification, taken together with the illustrations thereof presented in the accompanying drawings.